Debaty 2014.

Methods	Parallel‐group, randomized trial, February 2009 to August 2012, multicentre study
Participants	Total number of participants 245, mean age 67 years, 29% female, patients' average temperature at randomization: pre‐hospital cooling group 35.2°C, hospital cooling group: 35.4°C (estimated from graph) Inclusion criteria: OHCA participants over 18 years of age eligible for advanced life support were included irrespective of rhythm Exclusion criteria: participants with trauma participants with haemorrhage participants with asphyxia participants already hypothermic (temperature < 34°C) women who were obviously pregnant participants who had achieved ROSC before randomization participants with a do‐not‐attempt resuscitation order
Interventions	Intra‐arrest cooling, infusion of up to 2000 mL of ice‐cold 0.9% saline solution at 100 mL/min during cardiac arrest by use of a standard infusion set and a pressure bag inflated to 300 mmHg. Surface cooling was also induced using gel pads.
Outcomes	Types of outcome measures: Primary outcomes neuron specific enolase (NSE) at 24 hours Secondary outcomes IL‐6 concentrations during the first 72 h IL‐8 concentrations during the first 72 h IL‐10 concentrations during the first 72 h cooling rates ROSC rate length of stay in intensive care survival (discharge, 30 days and 1 year) neurological outcome comparing individual CPC scores (hospital discharge and 30 days)
Funding	French Society of Emergency Medicine
Declarations of interest	None
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization assignments were generated under a randomized permuted‐block design, with block sizes of 4, in a 1:1 allocation
Allocation concealment (selection bias)	Low risk	Each mobile intensive care unit was given sequentially numbered, sealed envelopes containing single randomization assignments
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information provided
Blinding of outcome assessment (detection bias) Good neurological outcome	Low risk	Neurological outcome at hospital discharge and 30 days was assessed by a physician blinded to the study allocation
Blinding of outcome assessment (detection bias) Survival	Low risk	Lack of blinding of survival data considered 'low risk'
Blinding of outcome assessment (detection bias) Adverse events	Unclear risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	Low risk	Analysis of clinical outcomes was according to intention‐to‐treat
Selective reporting (reporting bias)	Low risk	All expected outcomes included
Other bias	Unclear risk	No information on application of pre‐hospital cold fluids (which proportion of patients received how much) Over 24 hours of cooling the body temperature of the intra‐arrest cooling group seemed to be higher than the body temperature of the hospital cooling group According to the authors the study was not powered to show a clinical difference